California Court of Appeals, First District, Third Division
RICK L. SCHWARTZ, Plaintiff and Appellant,
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY et al., Defendants and Respondents.
Superior Court of the City & County of San Francisco, No. CGC-05-446073, Richard A. Kramer, Judge.
Counsel for Plaintiff and Appellant: SCHNEIDER WALLACE COTTRELL BRAYTON KONECKY LLP, Todd M. Schneider, Mark T. Johnson, BERGER & MONTAGUE, P.C., Steven L. Bloch, Peter R. Kahana
Counsel for Defendants and Respondents: PIERCE ATWOOD LLP, Gavin G. McCarthy, WILSON, ELSER, MOSKOWITZ, EDELMAN & DICKER LLP, Francis Torrence
An insured sued disability insurers alleging deceptive claims handling practices in violation of the unfair competition law (UCL) based upon the insurers’ former practice of wrongfully denying benefits to some insureds. (Bus. & Prof. Code, § 17200 et seq.) The trial court found that the insured, who was never denied benefits, lacked standing to pursue a UCL cause of action because the insured had not “suffered injury in fact” nor “lost money or property as a result of the unfair competition.” (§ 17204.) The court granted summary adjudication in favor of the insurers on the UCL cause of action. We shall affirm the summary adjudication ruling and subsequent judgment.
STATEMENT OF FACTS
Defendants Provident Life and Accident Insurance Company and related companies (collectively, insurers) sell disability insurance that provides monetary benefits to individuals who, due to injury or illness, are unable to work in their chosen occupations. Plaintiff Rick L. Schwartz is an insured under a policy he purchased in 1988 and maintains to date. Schwartz, a certified public accountant, chose the policy because he believed it was a good idea to “lock in a good premium” at a young age with a “non-cancelable, guaranteed renewable” policy. Schwartz pays a fixed monthly premium of $371.44 in exchange for the insurer’s promise to pay a monthly benefit of $11, 220 in the event of disability. Schwartz understood that his insurer would pay him the full benefits due under the policy if he became disabled, but would pay him no benefits and would retain the full amount of premiums paid if he did not become disabled. Schwartz has never become disabled and has never filed a claim for benefits.
In October 2005, the Commissioner of the California Department of Insurance (the commissioner) entered into a settlement agreement with the insurers resolving allegations that the insurers wrongly denied benefits to some insureds who had filed claims for benefits. Without conceding fault, insurers paid an $8 million civil penalty and agreed to re-evaluate claims previously denied and to modify their claims handling practices in the future.
Later that month, this action was filed on behalf of insureds who had not been denied benefits and therefore received no direct benefits from the settlement agreement. The operative second amended complaint filed by Schwartz pleads causes of action against the commissioner and the insurers. Schwartz alleged that the insurers operated a “systematic scheme” from 1994 to 2005 to deny and terminate legitimate disability claims by policyholders. Schwartz, and the purported class he represents, claimed injury from the alleged deceptive scheme despite no denial of benefits. Schwartz alleged that the insurers’ “systematic scheme to deny and terminate claims eliminated coverage under the disability income polices for all policyholders and, therefore, effectuated a reduction in coverage across the entire policyholder class. As a result, plaintiff and the classes paid premium dollars for units of coverage that were never afforded under the disability income policies, and [the insurers] breached the policies by not providing the units of coverage that plaintiff and the classes purchased with their premium payments. Moreover, given that the disability income policies were non-cancelable and guaranteed renewable, [the insurers were] prohibited from raising premiums for any reasons. Reducing coverage functioned as a de facto increase in premiums because coverage was eliminated but premiums remained the same. By increasing the premiums, [the insurers] breached the contracts of insurance with its policyholders and collected excessive premiums during the conspiracy period.”
Schwartz sought a writ of mandate to compel the commissioner to reopen his investigation and to accord relief to policyholders who, like Schwartz, had not been denied benefits but suffered the “economic injury” he posited. Schwartz stated several causes of action against the insurers, including a claim that their alleged deceptive claims handling practices violated the UCL.
The trial court dismissed the mandamus cause of action against the commissioner and we subsequently affirmed that order. (Schwartz v. Poizner (2010) 187 Cal.App.4th 592.) We held that “even on the questionable assumption that [Schwartz] and purported class members suffered economic harm as a result of the insurers’ claim practices that have now been corrected, the Commissioner was not required to pursue any remedy on their behalf” and his decision not to pursue additional remedies was not an abuse of discretion. (Id. at p. 600.)
In July 2011, for lack of standing, the trial court granted summary adjudication to the insurers on the UCL cause of action. (Code Civ. Proc., § 437c, subd. (f)(1).) The UCL provides relief to “a person who has suffered injury in fact and has lost money or property as a result of the unfair competition.” (§ 17204.) The court found that Schwartz failed to meet this standing requirement, noting that Schwartz “continues to pay his premiums, continues to have the identical coverage he always had, and has never filed a claim and has never had a claim denied.” Schwartz voluntarily dismissed his remaining causes of action and judgment was entered for the insurers. This timely appeal followed.
“The UCL prohibits, and provides civil remedies for, unfair competition, which it defines as ‘any unlawful, unfair or fraudulent business act or practice.’ (§ 17200.) Its purpose ‘is to protect both consumers and competitors by promoting fair competition in commercial markets for goods and services.’ ” (Kwikset Corp. v. Superior Court (2011) 51 Cal.4th 310, 320.) In 2004, the electorate “materially curtailed the universe of those who may enforce” UCL provisions. (Ibid.) The UCL was amended to confine standing to those actually injured by a defendant’s business practices. (Id. at p. 321.) As amended, the UCL provides that an individual may not prosecute a UCL claim unless the individual “has suffered injury in fact and has lost money or property as a result of the unfair competition.” (§ 17204.) “[P]roof of lost money or property will largely overlap with proof of injury in fact” and satisfy both elements. (Id. at p. 325 & fn. 8.) Proof of lost money or property—economic injury—may be shown in many ways: “A plaintiff may (1) surrender in a transaction more, or acquire in a transaction less, than he or ...